Objective To assess the impact of supplementing newborn infants with vitamin A on mortality at age 6 months.

Open burning of biomass fuel in the home is associated with significant health risks to the newborn child and young infant. Community-based trials are needed to clarify causal connections and identify effective approaches to reduce this burden of illnesses.

The regular provision of a supplement of vitamin A to children, at a level potentially obtainable from foods, in an area where vitamin A deficiency and under-nutrition are documented public health problems contributed substantially to children's survival; mortality was reduced on average by 54 percent.

Eye health has profound and widespread implications for many aspects of life, health, sustainable devel opment, and the economy. Yet many populations do not have access to goodquality, affordable eye care.Worldwide there are more than 250 million people living with vision impairment, among whom 36 million are blind. 1 In addition, over a billion people have near vision impairment, simply because they do not have a pair of reading spectacles. Eye conditions and the vision impairment they cause affect all stages of life, with increasing burden with age. Over the next 30 years, ageing and growth of the global population will lead to a tripling of people affected, with 700 million vision impaired and 115 million of these blind. 1 Critically, 80% of this sight loss is preventable or treatable, and 90% occurs in lowincome and middleincome countries (LMICs). Sight loss has substantial economic implications for affected individuals, families, and communities, with global estimates of annual costs exceeding US$ 3 trillion. 2 Good vision facilitates many activities of daily life and improves education and employment opportunities. Available good quality evidence shows that improved eye health offers the potential to advance progress towards the Sustainable Development Goals (SDGs), including those pertaining to poverty, hunger, good health and wellbeing, education, gender equality, and decent work. [3][4][5] Sight loss has many causes that require a range of promotive, preventive, curative, and rehabilitative inter ventions. Cataract, refractive error, agerelated macular degeneration (AMD), glaucoma, corneal opacity, and diabetic retinopathy are responsible for the majority of global vision impairment. 6 While interventions are available for these, there is a pressing need for research to improve detection, therapeutic efficacy, and implementation. Moreover, many of these interventions remain out of reach for millions living in underserved regions in LMICs as well as disadvantaged populations in highincome countries.In the quest to achieve universal eye health, a critical obstacle is the major shortage and maldistribution of appropriately trained personnel, particularly in Africa and rural areas within LMICs in other regions.

Adequate training of ophthalmologists in treating DR and improvement in eye-care infrastructure are needed to tackle this major public health problem in India.

Objective: To develop and evaluate the acceptability, reliability, validity, and responsiveness of the Indian vision function questionnaire (IND-VFQ). Methods: Problem statements from previous qualitative studies were reduced to a 45 item interviewer administered questionnaire representing three a priori domains (general functioning, psychosocial impact, and visual symptoms) which was evaluated in patients with cataract (n = 420), glaucoma (n = 120), diabetic retinopathy, or age related macular degeneration (n = 120) and normal controls (n = 120). Standard methods were used for item reduction and to evaluate psychometric properties. Results: Psychometric item reduction produced a 33 item questionnaire. Psychometric evaluation showed that two of the three scales (psychosocial impact and visual symptoms) had good acceptability, and that all three scales showed high internal consistency (alpha .0.80; item-total correlations 0.54-0.86) and testretest reliability (.0.89). All three scales showed moderate evidence of convergent and discriminant validity. Responsiveness, assessed in cataract patients (n = 120) before and after surgery, was good for all three scales (effect sizes .1). Conclusions:The IND-VFQ33 is a psychometrically sound measure of vision function addressing a gap in patient defined measures of vision function developed in populations living in low income countries.T his paper describes the development and psychometric evaluation of the Indian vision function questionnaire (IND-VFQ). Our earlier paper 1 presented the rationale for the questionnaire and described its content development. In brief, there is a lack of patient based measures of vision related quality of life developed for use in low income country settings and populations. The development of the IND-VFQ sought to redress this gap. With the current and predicted global burden of blindness highest in low income countries, 2 it is imperative that such measures are both available and relevant to health practitioners and their patient populations. The IND-VFQ is a new, patient based measure of vision related quality of life that was developed and field tested in three eye institutions in India. METHODS AND PARTICIPANTS Instrument developmentIn a previous paper we described how patients participated in the content development of the IND-VFQ by identifying the impact their vision problems had on their daily lives and psychosocial wellbeing.1 Approximately 5000 elicited problem statements grouped into 18 domain areas were reduced to 210 statements through a process of merging statements with a similar semantic meaning and context. We undertook a further process of item reduction by eliminating statements with low frequency counts (defined as problems reported by less than 10% of the patient population). This process resulted in 103 statements for inclusion in a draft questionnaire for preliminary field testing.Visual symptoms, psychosocial impact, and general functioning questions were assessed by a four point response scale (1 = not at all, 2 = a ...

South Indian infants experience high rates of pneumococcal carriage during the first 6 months of life, which may partially explain their increased risk for pneumonia.

Objective: To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region.Study Design: Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h.Result: Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at B78% higher risk of death (relative risk ¼ 1.78 (95% confidence interval (CI) ¼ 1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 12 h after birth.Conclusion: Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breastfeeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.